Ambulatory Care Pharmacy Rotation Comprehensive Orientation and Study Guide

Rotation Structure and Information Management

• V Drive Access: Access to the common V drive used by UF Health is limited for certain preceptors. Students must actively keep preceptors updated on the most current schedule and assignment status, as preceptors depend on student communication for rotation tracking.

• Communication Methods: Direct texting is preferred for urgent updates, such as illness or running late. Preceptors should be notified even in the middle of the night regarding illness to prevent the spread of sickness to patients. Preceptors typically silence notifications at night, so students should send updates as soon as they are aware of a situation.

• Preceptor Contact Numbers:

  • Emergency and general questions: $(352) \, 215-1815$

• Transition to In-Person Meetings: Orientation and various meetings have transitioned from Zoom to in-person formats, typically conducted on Monday mornings in coordination with clinic schedules.

Clinical Sites and Locations

• CareOne Clinic: Site for many daily activities, including psych days (Wednesdays) and chronic disease management (Thursdays).

• Med Plaza Internal Medicine: Located on the $4^{th}$ floor of the Med Plaza. To reach it, students must enter near the Subway; entering elsewhere leads to the oncology department.

  • Turn right upon entering the $4^{th}$ floor to reach the Internal Medicine clinic.

  • Facilities include a refrigerator and microwave for student use.

• Diabetes and Endocrinology Clinic: Managed by Dr. Yuan, located on the $3^{rd}$ floor of Med Plaza.

• Community Resource Program (CRP):

  • Location: $606 \, \text{Southeast Depot Avenue}$, nearby Depot Park.

  • Logistics: Parking is available at the site, which resembles a fire station.

  • Dress Code: Students are advised not to wear expensive shoes or their best clothing, as home visits may involve unclean environments, numerous animals, or poor house conditions.

• Dialysis Clinic:

  • Location: $2409 \, \text{Southwest 34th Street}$.

  • Logistics: Situated near the Wawa and Goodwill at the intersection of Archer Road and 34th Street. Parking is free.

Community Resource Program (CRP) Details

• Program Mechanics: CRP is run by EMTs and paramedics through grant funding. The program focuses on frequent flyers of the $911$ system and those frequently admitted to the Emergency Department.

• Chronic Disease Tuesdays: Tuesdays are specifically dedicated to patients with chronic diseases, similar to the patient population at CareOne.

• Services Provided:

  • Home assessments for safety (e.g., taping down loose rugs for fall prevention).

  • Connecting patients with social services, furniture, and food resources.

  • Medication management, including filling monthly pill boxes for patients who are blind or have suffered traumatic brain injuries (TBI).

  • Coordination with caregivers, such as advising shifts in care hours for dialysis patients who experience post-treatment weakness.

Academic Assignments and Requirements

• SOAP Notes: Students must complete $2$ comprehensive SOAP notes based on patients encountered at CareOne. These should be more detailed than standard daily documentation and utilize the template provided in the student folder.

• Drug Information (DI) Questions: Two DI questions are due by the final day of rotation. These should stem from clinical questions encountered during the rotation, such as comparisons between statins (e.g., pravastatin vs. rosuvastatin) or diabetes treatments. Responses should be uploaded to the V drive or emailed directly to the preceptor if V drive access is unavailable.

• Bulletin Board:

  • Requirement: One board per student.

  • Focus: Patient-facing educational materials on topics like nutrition, exercise, smoking cessation, or skin protection.

  • Printing: Recommended locations include the Architecture Library, CVS, or FedEx. The cost should be approximately $\$10$.

• Journal Club:

  • Students select three potential articles for approval.

  • Articles must be recent (published within the last $6 \, \text{months}$) and pertain specifically to ambulatory care (avoiding acute care topics like intubation).

  • Format: A PowerPoint presentation lasting approximately $20$ to $25 \, \text{minutes}$.

• Patient Case Presentation:

  • Duration: Approximately $20$ minutes.

  • Criteria: Focus on an interesting or controversial case where there might be different treatment approaches.

  • Examples: Lifestyle management vs. metformin for an $A1c$ in the $5 \text{ \%}$ range, or the use of hydralazine PRN.

Topic Discussion Curriculum

• Format: Students prepare a single-page medicinal handout for each topic to serve as a NAPLEX study guide.

• Anticoagulation:

  • Student 1: Oral agents, including DOACs and Warfarin.

  • Student 2: Injectable agents and bridging protocols.

• Diabetes:

  • Student 1: Oral agents (excluding oral GLP-1).

  • Student 2: Injectable agents, including the oral GLP-1 medication Rybelsus (semaglutide).

• Gastrointestinal (GI):

  • Joy Wright leads discussions on Ulcerative Colitis (UC) and Irritable Bowel Syndrome (IBS).

  • Student 1: Ulcerative Colitis meds.

  • Student 2: Irritable Bowel Syndrome meds.

• Informal Topics: Topics like osteoporosis, hypertension, and GERD are discussed toward the end of the day depending on time availability and patient cases; these require no prior preparation.

Critical Rotation Schedule and Dates

• Week 1 & 2: Standard rotation between Med Plaza, CareOne, and CRP.

• Dialysis Intensive: Tuesday and Wednesday of the third week are spent entirely in the dialysis clinic with Manny (consultant pharmacist). There are no Skills Lab or MTM duties during these two days.

• Midpoint Evaluation: Scheduled for Friday the $21^{st}$ after the Journal Club meeting.

• Labor Day: Rotation is closed on Monday for the holiday.

• Final Schedule Adjustments:

  • The final evaluation and patient case presentations are moved to Wednesday the $9^{th}$ from $2:00$ to $4:30 \, \text{PM}$ due to preceptor travel.

  • The final lunch with Joy Wright takes place on the last Friday ($11^{th}$), which is also the final deadline for the Bulletin Board.

Questions & Discussion

• Topic Discussion Preparation: Students asked if they need to prepare anything before the first discussion. The response was to prioritize the one-page medication handout for the assigned topics (Anticoagulation and Diabetes).

• Patient Case Selection: A student asked if the patient for the case presentation must be a patient they specifically saw. The answer is yes, the case must be based on a patient encountered during the rotation at any of the clinical sites.

• Scheduling Conflict: Due to a request for time off, Faiza and Ahmad agreed to swap CRP and Skills Lab days on Tuesday of the first week. Faiza will take the following Tuesday for CRP.